Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item The presence of strongyloidiasis and associated risk factors in patients undergoing treatment at the National Cancer Institute, Maharagama, Sri Lanka(Sri Lanka Medical Association, 2023) Weerasekera, C.J.; Menike, C.W.; Wimalasiri, U.; Wijerathna, T.; Jayathilake, D.C.C.; Somawardane, U.A.B.P.; Saravanamuttu, U.; Yoganathan, N.; Perera, N.; Gunathilaka, N.; de Silva, N.R.; Wickremasinghe, D.R.INTRODUCTION: Strongyloides stercoralis can cause severe disease in the immunocompromised. Without a proper gold-standard diagnostic technique, strongyloidiasis is scarcely studied both globally and locally. OBJECTIVES: We aimed to estimate the prevalence of strongyloidiasis among immunocompromised adult patients and to identify risk factors. METHODS: This study was carried out between February to October 2022. A faecal sample and 2 ml of venous blood were collected from consented patients. Direct faecal smear, agar plate, Harada-Mori and Charcoal cultures were performed on the faecal samples. Qualitative Polymerase Chain Reaction (PCR) was performed on selected faecal samples using S. stercoralis targeting ITS1 region. Strongyloides IgG ELISA was carried out on the serum samples using DRG Strongyloides IgG ELISA kit. RESULTS: Collectively, 144 patients (males = 68, females = 76) provided blood/faecal sample or both. Relevant to strongyloidiasis-associated symptoms, some patients had diarrhoea (n=12) and eosinophilia (n=11). Some of them (n=74) had occupational or recreational exposure to soil as potential risk factors. Overall, 24 patients were positive for strongyloidiasis from one or more diagnostic method (5 PCR and 19 ELISA). There were zero culture or direct smear positives. There was no significant association between disease positivity with either of the clinical features or risk factors. CONCLUSION: The prevalence of strongyloidiasis in patients with malignancies was 16.66%. Strongyloidiasis is existent in the immunocompromised in Sri Lanka even in the absence of suggestive clinical features or regular exposure to risk factors. Screening immunocompromised patients with sensitive techniques such as PCR for timely diagnosis and treatment is recommended.Item A preliminary survey for filarial parasites among dogs and cats in mahawewa, puttalam and their vector identification(Elsevier, 2022) Nimalrathna, S.; Mallwarachchi, C.; Chandrasena, T.G.A.N.; de Silva, N.; Kimber, M.; de Silva, N.R.; Harischandra, H.PURPOSE This study investigated the prevalence of zoonotic filarial parasites within the canine and feline population in Mahawewa, Puttalam, and their vectors based on a brugian filariasis positive human case reported to the Anti-filariasis Campaign in January 2021.METHODS & MATERIALS All reachable dogs and cats, both stray and domestic, within a 500m radius of the index human case of brugian filariasis were screened for microfilaria using Giemsa stained thick blood smears prepared from capillary blood, obtained from an ear-lobe prick. Mosquito collection was done using a dog-baited trap, two window traps and a B.G. Sentinel trap from the same study site and identified using morphological keys. The head and the thorax regions of randomly selected mosquito specimens were dissected for morphological identification of larval filaria parasites via microscopy. RESULTS A total of nine dogs and three cats were surveyed, of which seven dogs and one cat had filarial infections. All the infected animals harbored B.malayi microfilariae, while four dogs and one cat were co-infected with Dirofilaria repens and two dogs with an unidentified species. A total of 119 mosquitoes were caught and identified by taxonomic keys using a dog-baited trap, two window traps and a B.G. Sentinel trap from the study site. Dissection of heads and thoraces of randomly selected 12 Mansonia annulifera, 18 Mansonia indiana 20 Mansonia uniformis and 8 Culex spp. revealed filarial larvae in M.annulifera (n=4, 33.33%), M. indiana (n=14, 77.78%), M. uniformis (n=10, 50.00%) and Culex spp.(n=5, 62.5%) via microscopy. CONCLUSION M.indiana was incriminated as a potential vector of filarial parasites for the first time in Sri Lanka. Preliminary evidence generated indicate a high prevalence of B.malayi and D.repens among dogs and cats in Mahawewa, Puttalam with an abundance of mosquito vectors mostly of Mansonia and Culex spp. This warrants further studies with a larger sample size and molecular identification of the filarial larvae within mosquito and animal samples, especially as re-emergence of brugian filariasis in humans is being reported after four decades of quiescence, and a zoonotic brugian parasite has been detected over the recent past, raising a concern from a one health perspective.Item Lapses of professionalism occurring among Sri Lankan medical students: How should they be remediated?(Sri Lanka Medical Association., 2019) Ellawala, A.T.; Chandratilake, M.N.; de Silva, N.R.INTRODUCTION & OBJECTIVES: Early recognition and correction of lapses of professionalism occurring during 'the undergraduate period is vital. This study aimed to explore the lapses of professionalism occurring among local medical students and identify appropriate remedial measures. METHODS: The study was conducted in two phases. In Phase I, in-depth interviews and focus group discussions were conducted with medical teachers, clinicians, deans, students, nurses and patients (n= 129) to explore lapses they had witnessed. Conversations were audio-recorded, transcribed and analysed inductively. Description by multiple groups was considered an indicator of prevalence of a behaviour. In Phase II, a consensus conference with medical teachers, clinicians, deans and students (n=3 I), was conducted to achieve consensus on remediation strategies for identified lapses occurring as a first-time offence or a repeated behaviour pattern. Degree of consensus was based on modal distribution of responses. RESULTS: In Phase I, over 100 types of misconduct were described. The most common behaviours included, 'not doing allocated ward work', 'not contributing to group work' and 'several students examining a patient at the same time'. In Phase II, it was possible to achieve an acceptable level of agreement (50% or higher consensus) regarding remediation strategies for over 70% of the items, including almost all lapses identified as most common. Strategies ranged from 'ignore' to 'expulsion' and included measures such as discussion with peers, remedial work and counselling. CONCLUSION: Sri Lankan medical students exhibit a wide range of professionalism lapses of varying severity. The value of correcting such behaviour in a standardized manner is recognised.Item Introduction of Recombinase Polymerase Amplification assay based mobile suitcase laboratory as a point of need tool to diagnose cutaneous leishmaniasis in Sri Lanka(Sri Lanka Medical Association, 2018) Gunaratna, G.P.S.; Ranasinghe, P. H. K. I. S.; Manamperi, A.; Pathirana, N.; Pathirana, H.; Wickremasinghe, R.; de Silva, N.R.; Sooriyarachchi, M.; Ahmed, A.E.W.INTRODUCTION AND OBJECTIVES: Cutaneous leishmaniasis (CL) caused by the vector-borne protozoan parasite is now endemic in Sri Lanka. Microscopy of Giemsa stained slit skin smears (SSS), lesion aspirates or scrapings for the presence of amastigotes, is widely used for laboratory confirmation of CL, although the reported sensitivity is low. Facilities for more sensitive culture and molecular techniques are available only in reference laboratories. A newly developed, Recombinase Polymerase Amplification (RPA) assay based Mobile Suitcase Laboratory (MSL) is a promising, molecular point of care test with high sensitivity and specificity for diagnosis of both post-kala• azar dermal leishmaniasis and visceral leishmaniasis. Objective was to assess RPA based MSL as a point of need tool to diagnose CL in Sri Lanka.METHODS: Twenty seven army personnel at Mullaitivu Army camp clinically suspected of having CL were recruited for this pilot study. Two slit skin smears and two punch biopsy specimens were obtained from each of them. Slit skin smears were stained with Giemsa in the field and examined for the presence of amastigotes and RPA was carried out at the point of collection. PCR was performed at the Parasitology Department, Sri Jayewardenepura University. RESULTS: Fifteen patients were confirmed by PCR as having CL and 14 of them were also positive by RPA based MSL conducted in the field (93.33% sensitivity). Only 3/15 were positive with microscopy of SSS (20% sensitivity). CONCLUSION: This pilot study shows RPA based MSL as a promising tool to diagnose CL at point of need.Item Detection of a case of Brugian Filariasis from Anuradhapura, a non-endemic district of Sri Lanka(Sri Lanka Medical Association, 2018) Mallawarachchi, C.H.; Gunaratne, I.E.; Ekanayaka, G.M.G.A.C.; Mallawarachchi, S.M.N.S.M.; Chandrasena, T.G.A.N.; Mendis, D.; de Silva, N.R.INTRODUCTION AND OBJECTIVES: In 2016, the WHO declared that lymphatic filariasis was no longer a public health problem in Sri Lanka. However low-grade persistence of bancroftian filariasis continues in all three endemic provinces, while brugian filariasis has re-emerged. The periodicity pattern of the re-emerged Brugia spp. suggests zoonotic origin. A canine survey done in the district of Anuradhapura found a moderately high prevalence (28.2%) of B. malayi infections in the Thirappane MOH area. Objective of the study was to investigate the threat of zoonotic B.malayi infections to humans in the Thirappane MOH area. METHODS: A cross sectional survey was done among all consenting residents of three randomly selected areas representing the three PHI areas of the Thirappane MOH. Residents were screened between 8.00 pm and 12.00 pm using night blood smears (NBS) and Brugia rapid test (BRT) for presence of anti-Brugia IgG4 antibodies. BRT was done selectively. Ethical and administrative clearance was obtained prior to the survey. RESULTS: A total of 752 individuals were screened by NBS; 176 of them were also screened by BRT. 193, 208 and 351 NBSs were done respectively in Thirappane, Galkulama and Mooriyankadawala PHI areas. One individual, a 25-year-old long-term resident of Mooriyankadawala PHI area was positive for Brugia spp. microfilariae by NBS and by BRT. The microfilariae exhibited nocturnal sub-periodicity. CONCLUSION: Transmission of brugian filariasis appears to occur even outside the traditional endemic belt. The presence of canine reservoirs of infection and water bodies with aquatic vegetation probably favour transmission by Mansonia spp. vector mosquitoes in the study area.Item Effectiveness of mebendazole and health education in control of pinworm infection among children living in low income settlements(Sri Lanka Medical Association, 2017) Kumarendran, B.; Pathmeswaran, A.; de Silva, N.R.INTRODUCTION & OBJECTIVES: We aimed to evaluate the effectiveness of mebendazole (MBZ) mass treatment and health education in reducing reinfection with pinworm among children living in low income settlements (LIS). METHODS: A factorial cluster-randomized, controlled trial was conducted during January to May 2014, to compare the effectiveness of MBZ 100mg for positive cases versus mass treatment, and routine versus special health education. 1257 children aged 3-7 years, from 48 clusters of LIS in the Colombo Municipal Council area, were selected using cluster sampling. Perianal cellophane adhesive swabs (CAS) were examined for pinworm eggs. About 2-3 weeks after collection of the first sample (CAS1), depending on the intervention arm, eligible participants were given MBZ. Second sample (CAS2) was collected a week after administration of the first dose (MBZ1). Second dose (MBZ2) was given two weeks after MBZ1. Third sample (CAS3) was collected a week after MBZ2, and a fourth sample (CAS4) was collected 12 weeks after MBZ2. RESULTS: Sample collection rate was 94%, 80%, 75% and 73%, for CAS1, CAS2, CAS3 and CAS4 respectively. Overall egg positivity reduced from 42.5% to 10% following MBZ1, and to 6.8% following MBZ2, but increased to 29.3% at 12 weeks following MBZ2. In logistic regression, reinfection rate at 12 weeks after MBZ2 (i.e. those who were CAS3 negative but CAS4 positive) was associated with baseline pinworm egg positivity (OR=1.2) and BMI for age Z score (OR=0.96), but not with intervention arm. CONCLUSION: MBZ is effective in reducing pinworm egg positivity, but re-infection is common.Item Prevalence of pinworm infection among children living in low income settlements in Colombo Municipal Council area(Sri Lanka Medical Association, 2017) Kumarendran, B.; Pathmeswaran, A.; de Silva, N.R.INTRODUCTION & OBJECTIVES: Pinworm (Enterobius vermicularis) infection is associated with overcrowding and poor personal hygiene. We aimed to estimate the pinworm egg positivity (EP) rate among children living in low income settlements (LIS) in the Colombo Municipal Council (CMC) area, as there is no empirical evidence of prevalence. METHODS: This descriptive cross-sectional study was conducted during January - March 2014 as part of a clinical trial. Study population included children aged 3-7 years living in LIS in the CMC area for at least one year. Cluster sampling was used to select 1257 children, who were tested for pinworm infection using perianal cellophane adhesive swabs (CAS). Each child’s principal caretaker was educated to take the swabs early morning, immediately after awakening, on two consecutive days. CASs were examined by experienced technicians. EP was defined as EP on at least one of the two CAS. RESULTS: Sample collection rate was 94.3% (n=1185). Overall EP was 42.5 % (95% CI 39.7 - 45.4), but only 20.8% showed EP on both days. In logistic regression analysis, EP was associated with socioeconomic score (OR = 0.98), age of the child [from 3 years to 7 years] (OR= 1.02), BMI for age Z score (OR= 0.97) and increasing number of children aged 3 to 7 years in a household (OR= 1.05). CONCLUSION: A high proportion of 3-7 year old children living in LIS in the CMC area have pinworm infections. Prevention and control of this infection in LIS in the CMC area should be strengthened.Item Attributes of professionalism expected of a medical doctor in Sri Lanka(Sri Lanka Medical Association, 2016) Ellawala, A.T.; Chandratilake, M.N.; de Silva, N.R.INTRODUCTION: Professionalism is an essential competency for a doctor. OBJECTIVES: To identify the attributes of professionalism expected of a doctor in the Sri Lankan setting. METHOD: A two-round Delphi study was conducted online with the participation of 158 representatives of various stakeholders in healthcare. In the first round, participants outlined attributes of professionalism expected of a doctor in the local context. Through conventional content analysis, a list of attributes was compiled. These were rated by participants in round II. The most important attributes were identified by calculating the Content Validity Index (CVI) of responses. Kappa value was calculated to determine the adequacy of inter-rater agreement. RESULTS: In round I, 56 attributes of professionalism were identified. These items were compiled into a questionnaire with four distractors (i.e. misperceptions of professionalism) to minimize indiscriminate rating of items. In round II, 46 items received a CVI >0.78 (cutoff value to determine essential items). ‘Possessing adequate knowledge and skills’ received the highest CVI (0.99), followed by ‘displaying a sense of responsibility’ (0.98) and ‘being compassionate and caring’ (0.97). ‘Altruism’ and ‘socio-cultural sensitivity’ were not rated as important. Interestingly, one of the 4 distractors (‘stands for professional autonomy’) also received a CVI>0.78. The K-value was 0.77, indicating adequate inter-rater agreement. CONCLUSIONS: This study enabled the development of a prioritized list of professionalism related attributes expected of a doctor in Sri Lanka. The conceptualization of professionalism in the local healthcare context appears to have both commonalities and disparities with the rest of the world.Item The role of antioxidants in filarial infection(Royal Society of tropical medicine and Higiene (RSTMH), American Society of tropical medicine and Higiene(ASTMH), British Society for Parasitology, 2000) Premaratna, R.; Chandrasena, T.G.A.N.; Senarath, S.; Chandrasena, L.G.; de Silva, N.R.; de Silva, H.J.Abstract AvailableItem Clearance of microfilaraemia and red blood cell glutathione peroxidase(GPX) levels in asymptomatic microfilaraemics after single dose and 14 days’ treatment with diethyl carbamazine citrate(DEC) (Sri Lanka Medical Association, 2001) Premaratna, R.; Chandrasena, T.G.A.N.; Abeyewickreme, W.; de Silva, N.R.; Chandrasena, L.G.; de Silva, H.J.Abstract Available